Loss of Appetite in Older Adults: Causes and Practical Fixes

The "anorexia of ageing"

With age, several changes dampen appetite: the stomach empties more slowly and fills sooner, hormones that signal fullness rise while those that stimulate hunger may fall, smell and taste become less keen, energy needs fall because of less muscle and activity, and thirst and hunger signals blur. This "physiological anorexia of ageing" is common, but it raises the risk of undernutrition when other problems are added. It does not mean that a parent should simply be left to eat little.

Common causes to look for

Medical - Infections (urine, chest, tooth) and other acute illness. - Chronic diseases: heart failure, kidney disease, COPD, liver disease, diabetes, thyroid problems, anaemia, cancer, tuberculosis. - Gut problems: constipation (a very common and overlooked cause), acidity and reflux, ulcers, gallbladder problems, swallowing difficulty; see constipation in older adults: fibre, fluids and movement, acidity and reflux in older adults and swallowing problems (dysphagia) in older adults. - Pain, breathlessness or nausea. - Dehydration; see hydration for older adults: how much and how to remember. - Low sodium, high calcium, low zinc or B12, found on tests.

Medicines: a very frequent cause. Many drugs reduce appetite, alter taste or cause nausea or dry mouth, including some antibiotics, metformin, digoxin, chemotherapy, antidepressants, painkillers (including opioids), blood pressure medicines, water tablets and anticholinergics. Never stop a medicine on your own; ask the doctor to review; see medicine side effects families should watch for and polypharmacy and deprescribing.

Dental and mouth problems: missing or painful teeth, loose or ill-fitting dentures, gum disease, mouth ulcers, thrush, dry mouth; see teeth, dentures and eating well in later life and oral care for frail older adults and denture hygiene.

Taste and smell changes: from age, medicines, zinc deficiency, illness or after infections such as COVID-19.

Emotional and psychological: depression, grief, loneliness, anxiety, boredom; see depression in older adults and loneliness and isolation in older adults: practical ways to help.

Cognitive: dementia, where people forget to eat, do not recognise food, cannot use cutlery or become distressed at mealtimes; see dementia, eating and weight loss.

Practical and social: eating alone, difficulty shopping or cooking, hard-to-open packaging, difficulty feeding oneself, poor eyesight, tremor or arthritis in hands, financial constraints, unfamiliar food in hospital or care, rigid meal times, depending on a hired cook whose cooking they do not like.

Cultural and habit: fasting and restrictive religious diets, strict vegetarianism with limited choices, or family beliefs that "old people should eat light"; see fasting, festivals and older adults: staying safe.

First steps

1. Notice and measure. Weigh weekly on the same scale; see weighing scales and unplanned weight loss in older adults. Unplanned loss of around 5 per cent in three to six months, or noticeably loose clothes, is a warning. 2. Keep a food diary for three days: what and when the person ate and drank, how much, and any problems such as pain, nausea or coughing. 3. Ask the person what has changed: taste, teeth, pain, mood, constipation, sleep. 4. Check for treatable causes with the doctor: medicine review, blood tests, dental check, mood and swallowing assessment. 5. Screen for malnutrition, using a simple tool, and treat early; see malnutrition in older adults: signs and prevention.

Practical ways to eat more

### Little and often

• Offer six small meals rather than three large ones: breakfast, mid-morning, lunch, afternoon, dinner and a bedtime snack. Large plates can overwhelm; use smaller plates and serve small portions, with more offered later.
• Keep snacks within reach, such as a bowl of nuts, roasted chana, biscuits, fruit, laddoos and chikki in small portions, at the chair or bedside.
• Eat when hungriest. Many people eat best at breakfast; make that meal strong.
• Avoid filling up on fluids before meals; drink between meals.

### Fortify, do not just enlarge

Add energy and protein without increasing volume, ("food first," per the dietician):

• Add a teaspoon of ghee, butter or oil to dal, khichdi, rotis, vegetables and porridge, in measured amounts and with the doctor's agreement in heart disease or high cholesterol.
• Use full-fat milk, and add skimmed milk powder (two to three tablespoons) to milk, porridge, curd, kheer, soups, batter and dough.
• Add grated paneer, mashed egg, ground nuts, nut butter, sesame, seeds, besan or sattu to dishes.
• Make dalia, upma, poha or oats with milk and nuts rather than water.
• Choose energy-dense options: nut-based sweets in small portions, banana with milk, mango milkshake, curd with jaggery, kheer, halwa, sooji or ragi malt, khichdi with ghee, paneer parathas, egg bhurji, cheese sandwich.
• Blend soups with lentils, nuts or cream.
• Add protein at every meal; see how much protein do older adults need and high-protein Indian meals for seniors.

For people with diabetes, kidney disease or heart disease, use the diet plan advised by the doctor and dietician; see eating for diabetes after 60, eating with chronic kidney disease: a family guide and eating for heart health after 60.

### Make food appealing

• Flavour: older tastes may need stronger flavour; use herbs, lemon, ginger, cumin, coriander, curry leaves, tamarind and mild spices, unless reflux or other issues limit this. Reduce excessive salt; see eating for heart health after 60.
• Colour and presentation: bright vegetables, a garnish, small portions on a pretty plate.
• Smell: cooking aromas stimulate appetite; open the kitchen window or let the person sit near.
• Favourite and familiar foods, including regional and festival dishes, and food from the person's past.
• Temperature and texture: warm food smells better; soft texture for sore mouths; see soft and pureed diets.
• Variety, to avoid monotony; try small new things.
• Cold, sour or tangy foods (lemon, chaat, pickle in small amounts, chutney) can help when taste or nausea is a problem.
• If food tastes metallic, try plastic cutlery, cold foods and marinated or lightly sweet-sour dishes.

### Mealtime environment

• Eat together whenever possible. Company improves intake. Lonely meals suppress appetite.
• Calm, pleasant setting, with no television blaring, and unhurried time.
• Comfortable seating, upright posture, good lighting, glasses and dentures in place.
• Help with eating where needed, respectfully, without rushing; see feeding someone who cannot feed themselves and eating with tremor or weak grip.
• Adaptive cutlery and cups can restore independence; see easy-grip cutlery guide.
• Light activity such as a short walk before meals can stimulate appetite.
• Do not nag or force; pressure backfires. Offer, encourage, and let the person decide.
• Do not mix medicines into food without advice.

### Treat the small things

• Constipation and acidity often hide behind "no appetite".
• Mouth care and dentures.
• Pain relief before meals if pain limits eating.
• Antiemetics or other medicines only as the doctor prescribes.
• Sleep and mood.
• Fluids between meals.

Supplements and sip feeds

When food is not enough, a doctor or dietician may advise oral nutritional supplements (ready-made milkshake-like drinks with calories, protein and micronutrients), protein powders or fortified home recipes, usually taken between meals so that they do not replace them. Guidelines such as ESPEN's suggest considering supplements when dietary advice alone is insufficient. See nutrition supplements and sip feeds: when food is not enough and protein powder for older adults: who needs it and how to choose. A multivitamin may help if intake is very low; see multivitamins for older adults: helpful or wasteful?. Appetite-stimulating "tonics" and unprescribed medicines are not recommended; some contain steroids or other drugs. Medicines to stimulate appetite are sometimes used in specific settings under medical supervision.

Red flags: see a doctor soon

• Unintentional weight loss (about 5 per cent or more in three to six months, or noticeable within weeks).
• Sudden loss of appetite over days, especially with fever, pain, vomiting or confusion.
• Difficulty or pain on swallowing, coughing or choking at meals.
• Persistent nausea or vomiting.
• Blood in stool or vomit, black stools.
• Persistent abdominal pain or bloating.
• Drinking very little, dark urine or dizziness.
• Tiredness, breathlessness or swelling.
• Low mood, hopelessness or thoughts of not wanting to live: seek help promptly; call 112 if there is immediate danger.
• New cough, night sweats or fever (possible infection such as tuberculosis).
• A lump, or unexplained mouth ulcer.

When to ask a professional

Ask the doctor for a full review of poor appetite and weight loss, including medicines, mood, teeth, swallowing, blood tests and a cancer and infection check as needed. Ask a dietician for a fortified-food plan and advice on supplements. Ask a dentist about teeth and dentures, and a speech and language therapist about swallowing. Ask a pharmacist about medicine side effects. Seek urgent help for severe vomiting, dehydration, confusion, inability to swallow or collapse; call 112 if severe.